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Featured Articles

Spring 2008

Necessity Of Medical Personnel On The Advance Party

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Horsley GW, Wilson K. 08(2). 48 - 50. (Journal Article)

Abstract

Often when a unit sends an advanced echelon party forward, medical and preventive medicine personnel are not included. Medical planners make plans based upon their best estimates. Any opportunity for the medical personnel to gain ground truth prior to the deployment of the main body is an opportunity that should be taken. This article tries to reinforce this by providing a personal example. It also provides examples of effective preventive measures taken to decrease exposure to the filth fly.

Tympanic Membrane Perforation In Ied Blasts

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Depenbrock P. 08(2). 51 - 54. (Journal Article)

Abstract

Traumatic tympanic membrane (TM) perforation is a common finding in victims of IED blasts. Frequently it goes undiagnosed by medical providers on initial evaluation. Hearing loss, tinnitus, and vertigo are common complaints from Soldiers who have experienced acoustic trauma. Although symptoms are usually transient, their persistence is a cause for concern. Treatment of a ruptured TM is usually expectant. In certain instances specialty consultation is required. Since primary blast and neurologic injuries can accompany traumatic TM perforation, physicians should maintain a high index of suspicion for their presence. This article aims to address the pathophysiology, diagnosis, treatment, and associated complications of blast-induced tympanic membrane perforation. Objectives 1. Understand the biophysics of primary blast injury and how to prevent blast-induced acoustic trauma. 2. Understand the common presenting signs and symptoms of tympanic membrane rupture. 3. Understand the treatment of tympanic membrane rupture and the indications for specialty referral. 4. Understand the long-term complications associated with traumatic tympanic membrane rupture.

Casualty Wounding Patterns In Special Operations Forces In Operation Iraqi Freedom

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Royal J. 08(2). 55 - 60. (Journal Article)

Abstract

This report describes compiled data on wound patterns for casualties sustained by Special Operations Forces (SOF) of the Combined Joint Special Operations Task Force-Arabian Peninsula during Operation Iraqi Freedom. The intent of this report is to provide information to the SOF Medic on the types of combat-related wounds that are most common in the ongoing Iraq war. During the period evaluated, the extremities and the head were the most common wound sites. Extremity wounds were commonly associated with fractures. Most of the fatally-injured had head and/or neck wounds. The information in this report may be used by SOF Medics to focus training to better address the types of injuries that are commonly seen on the current battlefield and to plan operational and logistical aspects of combat trauma medicine. Objectives: 1. Describe common combat wound sites in SOF patients wounded in OIF. 2. Use wound pattern data to train and prepare for and execute emergency medical aspects of combat missions. 3. Provide guidelines for the compilation and analysis of SOF casualty data in future conflicts.

Veterinary Care System For Military Working Dogs - A Case Study

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Vogelsang R, Sofaly C, Richey M. 08(2). 61 - 67. (Case Reports)

Abstract

A previous JSOM article (Spring 2007) discussed military workings dogs (MWD) in SOF and their care by SOF medical personnel. MWDs are becoming more commonly utilized within SOF in current theaters and are subject to similar injuries and illnesses experienced by their human counterparts. SOF personnel can only provide basic care, as described in the earlier article, requiring more severely injured/ ill dogs be evacuated to a conventional veterinary treatment facility. This article discusses current conventional veterinary capability and utilizes a case study to help demonstrate the spectrum of veterinary care for MWDs, from point of injury, to CONUS rehabilitation and eventual return to duty. It is important that SOF medical and planning personnel understand what veterinary support exists, its capabilities and locations to ensure the best care possible can be provided to their dogs. OBJECTIVES 1) Understand conventional military veterinary support doctrine for working dog care. 2) Recognize potential problems/shortfalls within the veterinary care system. 3) Understand capabilities of conventional military veterinary care for the military working dog.

Air Force Special Operations Command Special Operations Surgical Team (sost) Conops

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Ervin MD. 08(2). 68 - 75. (Journal Article)

Abstract

The call for small surgical teams to provide direct support to SOF units has gained intensity over the last seven years. In July of 2003, the need for SOF specific Level II (including forward surgical support) was one of the top SOCOM medical lessons learned from OEF. In October of the same year, SOCOM put forth a tasking to develop organic resuscitative surgical capability within SOF. To respond to this tasking, the components looked to the existing smallest surgical units present in the services' inventories such as the FST, FRSS, and MFST. Army Forward Surgical Teams (FST) and Navy Forward Resuscitative Surgical Squadrons (FRSS) are designed to provide trauma care during maneuver warfare to battalion- sized forces and have delivered exceptional results in OIF. But even though these units are small compared to traditional Level III surgical hospitals, their size is too large to support emerging and short duration SOF missions. While other components were hindered by the lack of very small surgical units within their services' conventional inventories, AFSOC was able to rapidly acquire a few Air Force Mobile Field Surgical Teams (MFST) and begin developing the training, tactics, techniques, and procedures to meet the SOF community's needs. In doing so, it became clear that "SOF specific" surgical units serve a unique customer, must work within unique constraints, and must be agile enough to provide unique solutions. This paper presents the experiences and lessons learned in the ongoing development of the AFSOC Special Operations Surgical Team (SOST).

Clinical Diagnoses In A Special Forces Group: The Musculoskeletal Burden

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Lynch JH, Pallis MP. 08(2). 76 - 80. (Journal Article)

Abstract

The published literature contains little epidemiologic information concerning the spectrum of morbidity in Special Operations units. This study defines the burden of illness and injury seen in a Special Forces Group by quantifying the distribution of diagnoses. Excluding administrative categories, musculoskeletal conditions comprised 40% of all clinical diagnoses, raising the question of what more can be done to address the preventable causes of lost time due to injuries. We conclude there is need for increased training in the diagnosis and treatment of musculoskeletal injuries among all healthcare professionals assigned to Special Forces Groups as well as a need for increased education and resources to achieve better strength, conditioning, rehabilitation, and injury prevention for our units.

Needle Thoracostomy In The Treatment Of A Tension Pneumothorax In Trauma Patients: What Size Needle?

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Zengerink I, Brink PR, Laupland KB, Raber EL, Zygun D, Kortbeek JB. 08(2). 92 - 95. (Previously Published)

Previously published in The Journal of Trauma Injury, Infection, and Critical Care. 2008;64:111114. Permission granted by Lippincott Williams & Wilkins to republish in JSOM.

Abstract

Background: A tension pneumothorax requires immediate decompression using a needle thoracostomy. According to advanced trauma life support guidelines this procedure is performed in the second intercostal space (ICS) in the midclavicular line (MCL), using a 4.5cm (2-inch) catheter (5cm needle). Previous studies have shown a failure rate of up to 40% using this technique. Case reports have suggested that this high failure rate could be because of insufficient length of the needle. Objectives: To analyze the average chest wall thickness (CWT) at the second ICS in the MCL in a trauma population and to evaluate the length of the needle used in needle thoracostomy for emergency decompression of tension pneumothoraces. Methods: Retrospective review of major trauma admissions (Injury Severity Score >12) at the Foothills Medical Centre in Calgary, Canada, who underwent a computed tomography chest scan admitted in the period from October 2001 until March 2004. Subgroup analysis on men and women, <40 years of age and >40 years of age was defined a priori. CWT was measured to the nearest 0.01cm at the second ICS in the MCL. Results: The mean CWT in the 604 male patients and 170 female patients studied averaged 3.50cm at the left second ICS MCL and 3.51cm on the right. The mean CWT was significantly higher for women than men (ρ < 0.0001). About 9.9% to 19.3% of the men had a CWT >4.5 cm and 24.1% to 35.4% of the women studied. Conclusions: A catheter length of 4.5cm may not penetrate the chest wall of a substantial amount (9.9% - 35.4%) of the population, depending on age and gender. This study demonstrates the need for a variable needle length for relief of a tension pneumothorax in certain population groups to improve effectiveness of needle thoracostomy.

Chest Wall Thickness In Military Personnel: Implications For Needle Thoracentesis In Tension Pneumothorax

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Harcke HT, Pearse LA, Levy AD, Getz JM, Robinson SR. 08(2). 96 - 99. (Previously Published)

Previously Published in MILITARY MEDICINE. 172. 12:000.2007. Republished in JSOM with permission.

Abstract

Needle thoracentesis is an emergency procedure to relieve tension pneumothorax. Published recommendations suggest use of angiocatheters or needles in the 5cm range for emergency treatment. Multidetector computed tomography scans from 100 virtual autopsy cases were used to determine chest wall thickness in deployed male military personnel. Measurement was made in the second right intercostal space at the midclavicular line. The mean horizontal thickness was 5.36cm (SD = 1.19 cm) with angled (perpendicular) thickness slightly less with a mean of 4.86cm [SD 1.10cm). Thickness was generally greater than previously reported. An 8cm angiocatheter would have reached the pleural space in 99% of subjects in this series. Recommended procedures for needle thoracentesis to relieve tension pneumothorax should be adapted to reflect use of an angiocatheter or needle of sufficient length.